Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

OMNI JUG

Facility

$185.11

Hospital Charge Code	22354804
Hospital Revenue Code	270
Min. Negotiated Rate	$29.32
Max. Negotiated Rate	$166.60
Rate for Payer: Aetna of AZ Commercial	$166.60
Rate for Payer: Arizona Complete Health Allwell	$29.62
Rate for Payer: Banner UC Health Medicare	$29.62
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$125.87
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$29.62
Rate for Payer: Care1st Health Plan Arizona Medicare	$29.62
Rate for Payer: Cash Price	$148.09
Rate for Payer: Cigna of AZ Commercial	$129.58
Rate for Payer: Devoted Health Medicare	$33.32
Rate for Payer: Humana of AZ Medicare	$29.62
Rate for Payer: Southwest Service Administrators UFCW	$125.87
Rate for Payer: TriWest Medicare	$29.62
Rate for Payer: United Healthcare Commercial	$105.88
Rate for Payer: United Healthcare Medicare	$29.62
Rate for Payer: Veterans Affairs TRICARE	$29.32

OMNI JUG

Facility

$185.11

Hospital Charge Code	22354804
Hospital Revenue Code	270
Min. Negotiated Rate	$166.60
Max. Negotiated Rate	$166.60
Rate for Payer: Aetna of AZ Commercial	$166.60
Rate for Payer: Cash Price	$148.09

ondansetron 2 mg/mL Sol[CQCH]

Facility

$0.19

Service Code	HCPCS J2405
Hospital Charge Code	169831043
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
Rate for Payer: Cash Price	$0.16

ondansetron 2 mg/mL Sol[CQCH]

Facility

$0.19

Service Code	HCPCS J2405
Hospital Charge Code	169831043
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of AZ Commercial	$0.17
Rate for Payer: Arizona Complete Health Allwell	$0.03
Rate for Payer: Banner UC Health Medicare	$0.03
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.13
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.03
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.03
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of AZ Commercial	$0.12
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Humana of AZ Medicare	$0.03
Rate for Payer: Southwest Service Administrators UFCW	$0.13
Rate for Payer: TriWest Medicare	$0.03
Rate for Payer: United Healthcare Commercial	$0.11
Rate for Payer: United Healthcare Medicare	$0.03
Rate for Payer: Veterans Affairs TRICARE	$0.03

ondansetron 4 mg Dis Tab [CQCH]

Facility

$0.23

Service Code	HCPCS Q0162
Hospital Charge Code	105934883
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Aetna of AZ Commercial	$0.21
Rate for Payer: Cash Price	$0.19

ondansetron 4 mg Dis Tab [CQCH]

Facility

$0.23

Service Code	HCPCS Q0162
Hospital Charge Code	105934883
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.21
Rate for Payer: Aetna of AZ Commercial	$0.21
Rate for Payer: Arizona Complete Health Allwell	$0.04
Rate for Payer: Banner UC Health Medicare	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$0.04
Rate for Payer: Care1st Health Plan Arizona Medicare	$0.04
Rate for Payer: Cash Price	$0.19
Rate for Payer: Cigna of AZ Commercial	$0.15
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.04
Rate for Payer: Southwest Service Administrators UFCW	$0.16
Rate for Payer: TriWest Medicare	$0.04
Rate for Payer: United Healthcare Commercial	$0.13
Rate for Payer: United Healthcare Medicare	$0.04
Rate for Payer: Veterans Affairs TRICARE	$0.04

Ondansetron Hydrochloride, per 1 mg Injection

Facility

$16.00

Service Code	HCPCS J2405
Hospital Charge Code	2997571
Hospital Revenue Code	521
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Arizona Complete Health Allwell	$2.56
Rate for Payer: Banner UC Health Medicare	$2.56
Rate for Payer: Blue Cross Blue Shield of Arizona Commercial	$10.88
Rate for Payer: Blue Cross Blue Shield of Arizona Medicare	$2.56
Rate for Payer: Care1st Health Plan Arizona Medicare	$2.56
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cigna of AZ Commercial	$11.20
Rate for Payer: Devoted Health Medicare	$2.88
Rate for Payer: Humana of AZ Medicare	$2.56
Rate for Payer: Southwest Service Administrators UFCW	$10.88
Rate for Payer: TriWest Medicare	$2.56
Rate for Payer: United Healthcare Commercial	$9.15
Rate for Payer: United Healthcare Medicare	$2.56
Rate for Payer: Veterans Affairs TRICARE	$2.53

Ondansetron Hydrochloride, per 1 mg Injection

Facility

$16.00

Service Code	HCPCS J2405
Hospital Charge Code	2997571
Hospital Revenue Code	521
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of AZ Commercial	$14.40
Rate for Payer: Cash Price	$12.80

OOPHORECTOMY, PARTIAL OR TOTAL, UNILATERAL OR BILATERAL;

Facility

$4,838.00

Service Code	CPT 58940
Hospital Revenue Code	360
Min. Negotiated Rate	$4,838.00
Max. Negotiated Rate	$4,838.00
Rate for Payer: United Healthcare Commercial	$4,838.00

Open Craniotomy Except Trauma

Facility

$44,853.13

Service Code	APR-DRG 0214
Hospital Charge Code	APRDRG0211
Min. Negotiated Rate	$44,853.13
Max. Negotiated Rate	$44,853.13
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$44,853.13
Rate for Payer: Mercy Care Medicaid	$44,853.13
Rate for Payer: NaphCare Correctional Healthcare	$44,853.13

Open Craniotomy Except Trauma

Facility

$17,671.77

Service Code	APR-DRG 0212
Hospital Charge Code	APRDRG0212
Min. Negotiated Rate	$17,671.77
Max. Negotiated Rate	$17,671.77
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,671.77
Rate for Payer: Mercy Care Medicaid	$17,671.77
Rate for Payer: NaphCare Correctional Healthcare	$17,671.77

Open Craniotomy Except Trauma

Facility

$27,410.01

Service Code	APR-DRG 0213
Hospital Charge Code	APRDRG0213
Min. Negotiated Rate	$27,410.01
Max. Negotiated Rate	$27,410.01
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27,410.01
Rate for Payer: Mercy Care Medicaid	$27,410.01
Rate for Payer: NaphCare Correctional Healthcare	$27,410.01

Open Craniotomy Except Trauma

Facility

$44,853.13

Service Code	APR-DRG 0214
Hospital Charge Code	APRDRG0213
Min. Negotiated Rate	$44,853.13
Max. Negotiated Rate	$44,853.13
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$44,853.13
Rate for Payer: Mercy Care Medicaid	$44,853.13
Rate for Payer: NaphCare Correctional Healthcare	$44,853.13

Open Craniotomy Except Trauma

Facility

$13,508.96

Service Code	APR-DRG 0211
Hospital Charge Code	APRDRG0214
Min. Negotiated Rate	$13,508.96
Max. Negotiated Rate	$13,508.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,508.96
Rate for Payer: Mercy Care Medicaid	$13,508.96
Rate for Payer: NaphCare Correctional Healthcare	$13,508.96

Open Craniotomy Except Trauma

Facility

$17,671.77

Service Code	APR-DRG 0212
Hospital Charge Code	APRDRG0214
Min. Negotiated Rate	$17,671.77
Max. Negotiated Rate	$17,671.77
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,671.77
Rate for Payer: Mercy Care Medicaid	$17,671.77
Rate for Payer: NaphCare Correctional Healthcare	$17,671.77

Open Craniotomy Except Trauma

Facility

$44,853.13

Service Code	APR-DRG 0214
Hospital Charge Code	APRDRG0212
Min. Negotiated Rate	$44,853.13
Max. Negotiated Rate	$44,853.13
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$44,853.13
Rate for Payer: Mercy Care Medicaid	$44,853.13
Rate for Payer: NaphCare Correctional Healthcare	$44,853.13

Open Craniotomy Except Trauma

Facility

$44,853.13

Service Code	APR-DRG 0214
Hospital Charge Code	APRDRG0214
Min. Negotiated Rate	$44,853.13
Max. Negotiated Rate	$44,853.13
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$44,853.13
Rate for Payer: Mercy Care Medicaid	$44,853.13
Rate for Payer: NaphCare Correctional Healthcare	$44,853.13

Open Craniotomy Except Trauma

Facility

$27,410.01

Service Code	APR-DRG 0213
Hospital Charge Code	APRDRG0212
Min. Negotiated Rate	$27,410.01
Max. Negotiated Rate	$27,410.01
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27,410.01
Rate for Payer: Mercy Care Medicaid	$27,410.01
Rate for Payer: NaphCare Correctional Healthcare	$27,410.01

Open Craniotomy Except Trauma

Facility

$17,671.77

Service Code	APR-DRG 0212
Hospital Charge Code	APRDRG0211
Min. Negotiated Rate	$17,671.77
Max. Negotiated Rate	$17,671.77
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,671.77
Rate for Payer: Mercy Care Medicaid	$17,671.77
Rate for Payer: NaphCare Correctional Healthcare	$17,671.77

Open Craniotomy Except Trauma

Facility

$13,508.96

Service Code	APR-DRG 0211
Hospital Charge Code	APRDRG0213
Min. Negotiated Rate	$13,508.96
Max. Negotiated Rate	$13,508.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,508.96
Rate for Payer: Mercy Care Medicaid	$13,508.96
Rate for Payer: NaphCare Correctional Healthcare	$13,508.96

Open Craniotomy Except Trauma

Facility

$17,671.77

Service Code	APR-DRG 0212
Hospital Charge Code	APRDRG0213
Min. Negotiated Rate	$17,671.77
Max. Negotiated Rate	$17,671.77
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$17,671.77
Rate for Payer: Mercy Care Medicaid	$17,671.77
Rate for Payer: NaphCare Correctional Healthcare	$17,671.77

Open Craniotomy Except Trauma

Facility

$27,410.01

Service Code	APR-DRG 0213
Hospital Charge Code	APRDRG0211
Min. Negotiated Rate	$27,410.01
Max. Negotiated Rate	$27,410.01
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27,410.01
Rate for Payer: Mercy Care Medicaid	$27,410.01
Rate for Payer: NaphCare Correctional Healthcare	$27,410.01

Open Craniotomy Except Trauma

Facility

$13,508.96

Service Code	APR-DRG 0211
Hospital Charge Code	APRDRG0211
Min. Negotiated Rate	$13,508.96
Max. Negotiated Rate	$13,508.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,508.96
Rate for Payer: Mercy Care Medicaid	$13,508.96
Rate for Payer: NaphCare Correctional Healthcare	$13,508.96

Open Craniotomy Except Trauma

Facility

$13,508.96

Service Code	APR-DRG 0211
Hospital Charge Code	APRDRG0212
Min. Negotiated Rate	$13,508.96
Max. Negotiated Rate	$13,508.96
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$13,508.96
Rate for Payer: Mercy Care Medicaid	$13,508.96
Rate for Payer: NaphCare Correctional Healthcare	$13,508.96

Open Craniotomy Except Trauma

Facility

$27,410.01

Service Code	APR-DRG 0213
Hospital Charge Code	APRDRG0214
Min. Negotiated Rate	$27,410.01
Max. Negotiated Rate	$27,410.01
Rate for Payer: Blue Cross Blue Shield of Arizona Health Choice	$27,410.01
Rate for Payer: Mercy Care Medicaid	$27,410.01
Rate for Payer: NaphCare Correctional Healthcare	$27,410.01

Know your out-of-pocket cost for care.

All Charges